Microvascular dysfunction in Takotsubo syndrome: a systematic review.

Area of Science:

• Cardiology
• Cardiovascular Research
• Internal Medicine

Background:

• Microvascular dysfunction (MD) is a proposed key mechanism in Takotsubo syndrome (TTS).
• Existing research on MD in TTS lacks a comprehensive systematic review.
• This review synthesizes current evidence on MD in TTS.

Purpose of the Study:

• To systematically review and analyze studies investigating microvascular dysfunction in Takotsubo syndrome.
• To assess the prevalence, diagnostic methods, and clinical implications of MD in TTS.

Main Methods:

• A systematic search of major databases (Embase, Medline, Scopus, PubMed) was conducted.
• Studies published in English, focusing on microvascular function in human TTS patients, were included.
• Exclusion criteria included case reports, non-human studies, and investigations of non-cardiac microvasculature.

Main Results:

• 35 studies met the inclusion criteria, employing diverse techniques like angiography, invasive measurements (IMR), echocardiography, nuclear medicine, and CMR.
• Prevalence of MD in TTS varied widely (35%-100%) based on diagnostic criteria.
• MD was associated with increased systolic impairment and, in limited studies, higher rates of major adverse cardiovascular events and mortality.

Conclusions:

• MD prevalence in TTS is variable, and its absence in some cases questions its necessity for disease onset.
• The presence and extent of MD in TTS show promise as a prognostic indicator.
• Current evidence does not support MD in TTS as a confirmed therapeutic target in humans.